DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases

Contacting military personnel can be difficult due to frequent residence changes. To ensure expeditious handling of MC/WW cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary re-contact:

If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary re-contact.

If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:

Department of Defense issues a DD Form 214 for each period of active duty service. It contains important information for claims development.

If the claimant submits a DD Form 214(s), place a copy into the Shared Evidence Screen (EVID) or the Non-Disability Repository for Evidence (NDRed), or both.

IMPORTANT: To expedite handling of MC/WW claims, do not delay forwarding these claims to the DDS, even when the DD Form 214 is not readily available. Accept the claimant’s allegation that the disability occurred during military service without the DD Form 214 or other documentation. For additional information, see GN 00301.310 The Non-Disability Repository for Evidentiary Documents (NDRed) Application—Overview and MSOM EVID 001.002 Shared Processes Menu (SPMN).

Do not evaluate the claimant’s work activity based solely on military wages, without making an SGA determination, since active duty service members usually continue to receive full military pay while receiving medical treatment (for more information on evaluation and development of employment, see DI 10505.001). For example, the claimant may be working in a designated therapy program or on limited duty while receiving treatment. Instead, determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force. Always take into consideration any applicable work incentives (e.g., impairment-related work expenses [IRWE], subsidies or special conditions).

Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant was disabled for a continuous period of at least 12 months, but at the time of adjudication the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability. For additional information on closed period of disability, see DI 25510.010 Closed Period Under Title II and DI 25510.015 Closed Period Under Title XVI.

Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of SGA alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110 Return to Work.

When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., IRWEs, subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).

Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.

For more information on completing work activity reports and claims development, see:

Establish a UNIT code of “___XRQ” on the DW01 screen for claimants who meet the MC/WW definition in DI 11005.003A.1.

Use the first three characters of the unit code per local instructions (e.g., unit number, initials).

Establish an ISSUE of “MC/WW Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.

Although MC/WWs are expedited following the same procedures as TERI cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence of a terminal illness.

If the MC/WW flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) to create an MC/WW flag in EDCS. The flag will alert the DDS to expedite processing of the claim.

MC/WW claimants may be hospitalized when you are ready to transfer the claim to the DDS. To ensure that you send the claim to the correct DDS office, verify the claimant’s actual or last known physical residence address. DDS jurisdiction is not based on the claimant’s mailing address. For information on determining the DDS with jurisdiction of the claim, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

EDCS claims: Annotate the EDCS remarks section with the words “Military Casualty/Wounded Warrior Case.” For instructions on transferring a EDCS case, see DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).

EDCS exclusions: Send the paper case in a priority mail envelope with a “Military Casualty/Wounded Warrior Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations.

Obtain a DDS Query (DDSQ) two days after the claim is transmitted to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim is transmitted. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.

Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d. The Disability Interview-- Identifying Terminal Illness (TERI) Cases.

To process requests for AC review, send the request directly to the AC as indicated in DI 81010.150 Processing Claims Appeals of Medical Decision in Electronic Disability Collect System (EDCS) and DI 12020.001 Appeals Council (AC) Review.

If the MC/WW flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on MC/WW flagging, see DI 11005.006D.3. in this section).